Cost avoidance of pharmacist-led deprescribing using STOPPFrail for older adults in nursing homes

• DOI: 10.1007/s11096-024-01749-3
• Publication Date: 2024-07-05T05:01:45Z
• Authors: Eoin Hurley; Stephen Byrne; Elaine Walsh; Tony Foley; Noel Woods; Kieran Dalton
• Keywords: Male; Aged, 80 and over; Practice Patterns, Pharmacists'; Drug-Related Side Effects and Adverse Reactions; Cost-Benefit Analysis; Frail Elderly; Inappropriate Prescribing; Pharmacists; Nursing Homes; 03 medical and health sciences; Deprescriptions; 0302 clinical medicine; Cost Savings; Humans; Homes for the Aged; Female; Potentially Inappropriate Medication List; Research Article; Aged

Abstract Background The Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy (STOPPFrail) criteria aim to reduce inappropriate/unnecessary medications in frail older adults, which should minimise adverse drug events and additional healthcare expenditure. Little is known about the economic outcomes of applying these criteria as an intervention.

Aim To evaluate cost avoidance of pharmacist-led application of STOPPFrail to frail older nursing home residents with limited life expectancy.

Method Pharmacist-identified STOPPFrail-defined potentially inappropriate medications that were deprescribed by patients’ general practitioners were assigned a rating by a multidisciplinary panel, i.e. the probability of an adverse drug event occurring if the medication was not deprescribed. The intervention’s net cost benefit and cost–benefit ratio were then determined by factoring in adverse drug event cost avoidance (calculated from probability of adverse drug event ratings), direct cost savings (deprescribed medication costs/reimbursement fees), and healthcare professionals’ salaries.

Results Of the 176 potentially inappropriate medications deprescribed across 69 patients, 65 (36.9%) were rated as having a medium or high probability of an adverse drug event occurring if not deprescribed. With €27,162 for direct cost savings, €61,336 for adverse drug event cost avoidance, and €2,589 for healthcare professionals' salary costs, there was a net cost benefit of €85,909 overall. The cost–benefit ratio was 33.2 and remained positive in all scenarios in sensitivity analyses.

Conclusion Pharmacist-led application of STOPPFrail to frail older nursing home residents is associated with significant cost avoidance. Wider implementation of pharmacist interventions in frail older nursing home residents should be considered to reduce potentially inappropriate medications and patient harm, alongside substantial cost savings for healthcare systems.